MEDICARE: EMMANUEL HEALTHCARE SYSTEM, INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251E00000X	Home Health Agency

General Provider Information

NPI Number	:	1871761999
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	EMMANUEL HEALTHCARE SYSTEM, INC

Provider Business Mailing Address
First Line	:	4132 KATELLA AVE
Second Line	:	SUITE 106
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	714-300-8802
Fax Number	:

Provider Business Practice Location Address
First Line	:	4132 KATELLA AVE
Second Line	:	SUITE 106
City	:	LOS ALAMITOS
State	:	CA
Zip	:	90720-3426
Country	:	US
Telephone Number	:	714-300-8802
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. ROLANDO EDROSA SESE
Credential	:
Telephone Number	:	714-300-8802

Provider Enumeration Date	:	02/11/2008
Last Update Date	:	02/11/2008

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